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SSRI-ously: my first 100 days on fluoxetine

Extreme honesty alert! If you don’t like reading unfiltered accounts of mental health stuff, don’t read this blog post. It even contains the words “my sex drive”, in that order. Don’t say I didn’t warn you…

I know, I know. Mental Health Awareness Week was last week. I really meant to write this post then, but I was distracted by other things. Alternatively, by posting it today I’m making a statement on how we need to be aware of mental health all year round, not just for one week. Take your pick.

I mentioned in my last serious post that I’d just been prescribed fluoxetine. I’ve now been taking it for over 100 days. Fluoxetine is probably more widely known by the trade name Prozac, and it’s an SSRI (selective serotonin reuptake inhibitor), a kind of antidepressant which, in the lamest of layman’s terms, makes the happy chemicals in your brain stick around longer than they normally would. At least in the UK you can’t buy it over the counter; it has to be prescribed by a doctor. That’s the main reason I feel okay about writing what I’m about to write. Let’s be clear: I am about the furthest thing from a doctor that the human race has yet produced. Everything I say from here on is based purely on my own personal experience, and should be overridden by anything you hear in a consultation with an actual medical professional.

That said: based on the 100 or so days I’ve been taking it, fluoxetine is a goddamn miracle.

No, it hasn’t fixed all my problems. I never expected it to. To be honest, part of me never thought it would do anything at all. But it has. My life situation hasn’t changed much (yet; I’m working on it), but I feel much more stable and happy than I did at the beginning of the year. Back then, I was getting to a point where I would often avoid social gatherings even with my closest friends because I felt like I was being antisocial and because I couldn’t stop myself falling into a pit of hopelessness immediately afterwards. Today I still have plenty of insecurities, but they don’t overwhelm me; little things don’t snowball into massive avalanches in my head, petty jealousies are easier to let go of, and I think I’m a nicer person to be around.

To clear a few things up, I’m going to respond to some of my own doubts which I had before I started taking antidepressants.

Maybe I’m not actually depressed? Maybe this is how everyone feels, and they’re all just better at dealing with it than I am? I mean, how could anyone NOT feel this way when there are so many things in life to worry about?

There is no objective way to measure feelings, of course, but any doubts I may have had that I was actually depressed have been completely dispelled by the change in my moods since taking fluoxetine. I don’t exactly wake up singing every morning, but I also haven’t had any more of those why-should-I-keep-breathing days recently. I look back on those days now and I recognise them for what they were: signs that I was badly in need of help. I can’t say for certain that I’ll never have one of those days again, but I haven’t yet. Everything has been lifted up a bit. Bad days are now okay days, okay days are now good days.

I’m also finding it easier to relate to other people, in a way that suggests what I’m feeling now is closer to what they feel most of the time. Suddenly I can understand other people’s seemingly superhuman ability to brush off the sorts of little things that used to burrow into my brain and eat me from the inside out. I can understand why other people don’t feel the urge to message their friends after every single social gathering to apologise and ask if they’re still friends. It’s not that they secretly feel just as sad and insecure as I did and are better at keeping it bottled up. It’s that mentally healthy people just DON’T go spiralling into despair at the tiniest provocation, the way I used to. If they did, the world would not function even to the dubious extent that it’s functioning at the moment. So, if you feel crushingly sad on a regular basis and wonder how on earth other people can cope, I would posit that this is probably depression and that you should seek help.

Okay, if I take antidepressants I might not feel as downright miserable as I do now, but I’ll be forever wandering about in an artificial chemical haze, unable to feel much of anything at all. Isn’t being sad better than that?

This was my biggest concern before I actually tried taking fluoxetine. That the medication would make my brain fuzzy and slow. That all the vivid colours of emotion would blur together into a grey sludge. That the depression would still be there – covered up, perhaps, like furniture under a sheet – unseen but always THERE, an invisible, silent, unsettling presence.

That is not remotely how it feels to be on fluoxetine. It feels, to me, as though I finally have things in perspective – not that fluoxetine has tricked me into thinking the world is great when it isn’t, but that it has corrected an error in my brain that made me see everything as awful when it wasn’t. Things are actually clearer now; if anything made the world seem fuzzy and grey and unsettling, it was the depression that gripped me before.

I can certainly still SEE the bad stuff, and even feel bad about it. But I can see the good stuff now too. The distinction between bad and good is sharper, and I seem to have lost my joy-stifling tendency to think of good stuff as bad stuff in disguise because it will some day betray me by coming to an end. I’m still capable of feeling happy and sad and angry and shocked. But my default mood has shifted. Whereas before, left to its own devices, it tended to drift back towards lonely, angry, hopeless self-hatred, it is now anchored in a much calmer, more rational place. Sometimes this takes me by surprise; I’ll catch myself feeling happy, or at least contented, and I’ll think “wait, what are you feeling like that for?”. And then I think “oh yeah, I do have quite a few reasons to be happy, don’t I?” Which is pretty much the opposite of the spiral I’ve been getting trapped in for the last few years.

But if you get rid of depression, aren’t you getting rid of a useful motivator to make your life better?

ABSOLUTELY NOT. This is a question that fundamentally misunderstands the nature of depression. Depression is the opposite of a motivator. It’s the sense that there isn’t any hope of making things better, and that you wouldn’t deserve it even if there was.

As proof that fluoxetine isn’t just a pill to make you accept whatever crappy situation you find yourself living in, I will say this: there are many aspects of my life that I’m not happy with. The main difference now is that they don’t prevent me from enjoying the aspects I am happy with. I can be upset that I don’t have a job, and still love hanging out with my friends. I can wish I had a cute human or pangolin to cuddle up to at night, and still enjoy curling up with a good book. I am able to feel good about the ways in which I am lucky, and still aspire to do more with my life. You know, like people are supposed to.

Surely there must be better ways of achieving the same thing, without using medication?

For some people I’m sure there are, and they’re certainly worth trying too. But the hardline anti-antidepressant stance that some people take strikes me as sort of a weird holdover from a (mostly) bygone era when mental illnesses weren’t considered as “real” as physical illnesses. If I had an infection I wouldn’t try to “think” myself better – that idea would have more than a whiff of new age absurdity about it. No, I’d go to the doctor for some antibiotics. Obviously this is an oversimplification, as many mental illnesses can and have been successfully treated using non-pharmaceutical techniques like cognitive behavioural therapy. But to outright reject the use of a drug that has been clinically proven to work, at least for some people, seems misguided.

Does fluoxetine have any side effects?

For me: nothing that is anywhere near as bad as the depression was. I am sleeping quite a lot. Often I’ll get tired in the middle of the day and have to take a nap, which I didn’t used to like doing. But this may just be my body catching up on all the sleep I’ve lost to depression, anxiety and panic attacks over the last few years. I’ve also had some strange and elaborate dreams, but nothing too nightmarish.

Aside from that, my stomach felt a bit odd for my first few days on fluoxetine, but after a week it was fine. Also, this may be a little TMI, but my sex drive has been reduced quite a bit. Not the sort of thing I’d normally bring up, but as I actually want this post to be informative I thought I’d better mention all the side effects rather than getting squeamish about them.

Also, I know I said I’m not a doctor, but I have been told BY a doctor that for most people there are no serious long-term risks to taking fluoxetine, so, prescriptions permitting, you can pretty much keep taking it for as long as you need to.

Hey, um, I know I’m supposed to be your pre-fluoxetine past self, but you’re being so effusive that I just have to break character and ask: are you being paid by Big Pharma to write this?

No. And I have no idea who produces fluoxetine or how ethical they are. All I’m saying is that for me, it works. (And I’m not trying to convince you to spend money on anything, because where I live this kind of healthcare is free, as it should be everywhere.)

For you, it works. Okay. But what if this is just some weird you thing?

It could well be. But the reason I wanted to write this is because I haven’t read much stuff about antidepressants that’s as unambiguously positive as my experience so far has been. Understandably, self-help books, NHS websites etc. tend to be quite cautious when talking about them, emphasising that they’re not for everyone, and stopping short of fully endorsing them. And yeah, I’m sure they’re not appropriate to every situation, they won’t work for everyone, and some people will suffer side effects. But, purely based on my own experience, and to avoid adding to the pile of frustratingly tentative prose about antidepressants, I will say this: if you think you are depressed and you just don’t know how to go about feeling better, you SHOULD at least ask your doctor about fluoxetine. It might not work for you, or it might give you bad side effects, in which case you should of course stop taking it. Even if it works, it won’t solve all your problems in one fell swoop.

But in my case it’s made a world of difference. I can’t promise it will for you too, but I promise it’s worth trying.

Footnote: just in case anyone reading this has social anxiety issues similar to mine, I feel I should also mention that it is perfectly fine to take a friend or family member to the doctor with you. Lots of people do it, and it can be very reassuring to have someone else there to back you up.